Fibrinogen and Fibrin Degradation Products’ Levels in Cardiopulmonary Bypass with Mild-Hypothermia versus Normothermia

Background: Coagulation cascades are activated during Cardiopulmonary Bypass (CPB) and their proper monitoring and maintenance determine the outcomes of operation to a big extent. Here, we assessed serum fibrinogen and Fibrin Degradation Products (FDP) in adult patients undergoing CABG with using CPB, either with hypothermia or normothermia. Materials and Methods: In a cross-sectional study, 80 adult patients’ candidate for elective CABG were randomly assigned into two groups: hypothermia and normothermia to assess fibrinogen and FDP, perioperatively. Results: Patients included 32 men (80%) in the hypothermia group and 26 men (60%) in the normothermia with the mean age of 61.43 ± 12.64 years. The mean temperature in the hypothermia group was 32.33 ± 1.44 and 35.33 ± 0.71 in the normothermic group. Differences in fibrinogen levels between the two groups were not significant (Fib before CPB, P=0.893, and Fib after declamping, P=0.057). The serum level of FDP before and during CPB was not significantly different in hypothermia and normothermia groups (P=0.412, P=0.778, respectively). Conclusion: During cardiac surgery in hypothermia and normothermia conditions rate of fibrinogen decreased 25% after declamping in each group; this decrease seems to be due to hemodilution. FDP levels were similar in both groups

Hemodynamic stability and analgesic effects of intravenous dexmedetomidine premedication in adult patients undergoing coronary artery bypass graft surgery

Background: Sternotomy for coronary artery bypass surgery operation is associated with neuropathic pain, hypertension, tachycardia, agitation, and several other complications. In severe cases, the neuropathic pain may result in arrhythmia which is an important concern in cardiopulmonary bypass surgeries. Premedication for reducing the risk of hemodynamic instability, neuropathic pain, and other adverse associated consequences is very important. Objectives: We Scrutinized the effects of dexmedetomidine intravenous infusions on hemodynamic parameters and postsurgical pain in coronary artery bypass patients. Patients and Methods: A total of 60 coronary artery bypass surgery patients were recruited and were randomly allocated into two groups. 31 patients received placebo, and 29 received 1 μg/kg of dexmedetomidine 10 min before anesthesia and then 0.4 μg/kg/h of dexmedetomidine until the end of the operation. Heart rate, blood pressure, and postsurgical pain score according to the numerical rating scale were measured and recorded after recovery from anesthesia. Results: Blood pressure significantly decreased after bolus administration of dexmedetomidine which remained lower at the end of screening in most of the times. No remarkable adverse effects were observed, and its consumption was associated with significant reduction in the postsurgical pain scores as measured in 2, 4, and 6 h after surgery as well as the time of extubation. Conclusions: Infusion with 1 μg/kg of dexmedetomidine 10 min before anesthesia and 0.4 μg/kg/h of dexmedetomidine from the time of sternum closure until the extubation time appears to be effective for the maintenance of hemodynamics in coronary artery bypass surgery without remarkable adverse outcomes

Correction: Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis

Background: Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. Methods: This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. Results: The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. Conclusions: TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%